Diabetic Foot Flashcards
What complications of diabetes contribute to the development of diabetic foot?
Micro = neuropathy Macro = peripheral vascular disease
What are some epidemiological facts about foot disease in diabetes?
Prevalence of diabetes in England and Wales = 2-3 %
Prevalence of current or past foot ulceration in diabetes: 5 - 7 % (about 50,000 in England and Wales)
Risk of amputation up to 60× in diabetes. Poor subsequent prognosis.
10 % of NHS bed occupancy due to diabetes related problems (50% foot disease)
What is used to investigate light touch on feet?
A piece of monofilament is applied to the foot - when the monofilament bends, you are applying 10g of foot
Helps detect neuropathy
What are clawed toes?
Increased pressure on the metatarsal head
Flexed toes
Due to motor neuropathy
Long extensors and flexors on the toes are applying pressure inappropriately on the plantar surface on the foot
Greatest risk of ulcer = big toe meta-tarsal head
What is the pathway?
Sensory neuropathy
Motor neuropathy
Limited joint mobility
Autonomic neuropathy
Peripheral Vascular disease
Trauma – repeated minor/discrete episode
Reduced resistance to infection
Other diabetic complications
- e.g. retinopathy
Why can they not put their hands together flat against each other?
Glycosylation of the tendons in the hand
So the hand cannot bend properly
Limited joint mobility
Why might they have very dry feet?
Autonomic neuropathy
ANS is important for sweating and control of grease in the feet and skin
What is peripheral vascular disease?
Arteriole run off to the feet = reduced due to atheroma
What are the differences between a neuropathic foot VS an ischaemic foot VS a neuroischaemic foot?
Neuropathic = numb, warm, dry, palpable foot pulses, ulcers at points of high pressure loading (first metatarsal head)
Ischaemic = (ischaemia and infection can be painless until it reaches the bone) cold, pulseless, ulcers at the foot margins
Neuro-ischaemic = numb, cold, dry, pulseless, ulcers at points of high pressure loading and at foot margins
How can you assess the foot of a diabetic patient?
Appearance - Deformity? Callus?
Feel - Hot/ cold? Dry?
Foot pulses - dorsalis pedis / posterior tibial pulse
Neuropathy - vibration sensation, temperature, ankle jerk reflex, fine touch sensation
What is the preventative management for development of diabetic foot?
Control diabetes - glycaemia / lipids / BP Inspect feet daily Buy comfortable shoes Buy shoes with laces to adjust width Inspect inside of shoes for foreign objects Cut nails straight across Care with heat Never walk barefoot
What is the MDT for the management for diabetic foot?
MDT team - diabetologist, diabetes nurse, chiropodist, orthopaedic surgeon, vascular surgeon, orthotist, limb fitting centre
How are foot ulcerations managed?
Relief of pressure - bed rest (risk of DVT, heel ulceration) or redistribution of pressure / total contact cast
Antibiotics, possibly long term
Debridement - removal of dead tissue
Revascularisation - vascular surgeon improves blood flow to the region (angioplasty / arterial bypass surgery)
Amputation
What is Charcot’s foot?
How does it present?
Charcot neuropathic osteoarthropathy (CN)
Condition affecting the bones, joints, and soft tissues of the foot and ankle, characterized by inflammation in the earliest phase
U-shapes foot - hot, red, inflamed foot, but no ulcer
Typically in the midfoot - midfoot subarticular
Pressure loading is incorrect and abnormal
Although this is painless in the patient
Normally we use joint sensation to distribute weight appropriately - this is compromised in neuropathy
There are 2 possible outcomes from (a neuropathic) diabetic foot - osteomyelitis and active charcot.
What is the difference between osteomyelitis VS active charcot?
Osteomyelitis =
Hot red foot with ulcer
Charcot =
hot red foot without ulcer
